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Biomedical subjects

J Wlodarczyk

Publications and source records attributed to J Wlodarczyk.

At least 37 records · Page 2Linked to original sources
PubMed1995

Using quality-control analysis of peak expiratory flow recordings to guide therapy for asthma.

OBJECTIVE: To compare the action points in published asthma management plans with those derived from quality-control analysis of peak expiratory flow recordings. DESIGN: Longitudinal observational study. SETTING: An ambulatory asthma education and management program in a tertiary care hospital. PATIENTS: 35 adults with asthma and exacerbation of asthma. MEASUREMENTS: Peak expiratory flow diaries and symptom recordings. RESULTS: Asthma action points from published asthma management guidelines had poor operating characteristics. The success rate was 35% when the action point was a peak expiratory flow rate less than 60% of the patient's best peak flow. The success rate improved to 88% when the action point was a peak expiratory flow rate less than 80% of the patient's best peak flow. Published action points had a high failure rate. Peak flow decreased to below the published action points during a stable period of asthma in 7% to 51% of patients studied. Action points defined using quality-control analysis did significantly better. A peak flow value less than 3 standard deviations below the patient's mean peak flow detected 84% of exacerbations and had a low failure rate (19%). Other quality-control tests had sensitivities of 91% and 71%. Quality-control action points could detect exacerbations up to 4.5 days earlier than conventional methods. CONCLUSIONS: Individualized action points can be derived for patients with asthma by applying quality-control analysis to peak flow recordings. These action points are more sensitive in detecting exacerbations of asthma and have fewer false-positive results. Action plans developed in this manner should be more useful for the early detection of deteriorating asthma.

Adrenal Cortex Hormones↗
PubMed1994

Accuracy of reported family history of heart disease: the impact of 'don't know' responses.

BACKGROUND: Usual 'Yes/No' definitions of a family history of heart disease do not allow for 'Don't know' responses. In some families, misclassification of family history may result if these are not considered. AIMS: To study the accuracy of family history reporting and the impact of 'Don't know' responses. METHODS: We compared reported family history of coronary heart disease (CHD) and cancer among 360 deceased relatives of 59 probands with 'gold standard' diagnoses recorded on official death certificates. RESULTS: For first degree relatives, sensitivity of reporting was 81% for CHD, 86% for any heart disease and 60% for cancer, while for second degree relatives, sensitivity was 73%, 69% and 90%, respectively. When 'Don't know' responses were classified as 'No', sensitivity in first degree relatives was not affected, but in second degree relatives, it fell to 49%, 41% and 60%, respectively. Specificities were unchanged. These data show that in families where information beyond first degree relatives is considered, failing to account for 'Don't know' responses is likely to lead to misclassification of family history of CHD.

Adult↗
PubMed1994

Correlation of serum ferritin levels and postsclerotherapy pigmentation. A prospective study.

BACKGROUND: Postsclerotherapy pigmentation is a common sequela of sclerotherapy to varicose and telangiectatic leg veins. This pigmentation is thought to be due to hemosiderin deposition in the dermis. A preliminary study indicated that serum ferritin was a good indicator of susceptibility to postsclerotherapy pigmentation. OBJECTIVE: To clarify the relationship between serum ferritin and postsclerotherapy pigmentation using a prospective study. METHODS: Serum ferritin levels were taken from 233 consecutive patients prior to commencement of sclerotherapy. Patients were assessed clinically for the presence of pigmentation at 3, 6, and 12 months. RESULTS: There was a linear relationship between pretreatment serum ferritin level and the occurrence of pigmentation at each posttreatment assessment date. CONCLUSION: The results confirm a relationship between serum ferritin levels and postsclerotherapy pigmentation. This indicates that a significant predisposing factor to the development of persistent postsclerotherapy pigmentation is a high level of total body iron stores.

Adult↗
PubMed1993

Living near a lead smelter: an environmental health risk assessment in Boolaroo and Argenton, New South Wales.

This paper outlines a risk assessment of a lead-contaminated residential site in Lake Macquarie, New South Wales, near the Pasminco Metals-Sulphide lead and zinc smelter. The assessment includes a hazard identification and a dose-response assessment based on recent research findings; an exposure assessment based on two interrelated indicators, soil/dust lead and blood lead; a risk characterisation; and finally, a discussion of environmental and behavioural options for the management of risk. The exposure assessment showed lead concentrations of 20 to 21,460 parts per million in soil survey samples, 23 to 35,870 parts per million in household dust, and a range of mean values for blood lead concentration of 11 micrograms/dl to 17 micrograms/dl, in four study groups. The proportions of children within these groups having blood lead concentrations of 10 micrograms/dl or greater, the current level of known health effect, ranged from 57 per cent to 85 per cent. The decision by the National Health and Medical Research Council in June 1993 to set a goal for blood lead of below 10 micrograms/dl has important implications for the definition and the management of the environmental health risk from 'living with lead' in the area assessed.

Child↗
PubMed1993

The effect of prazosin on patients with symptoms of benign prostatic hypertrophy.

OBJECTIVE: To evaluate the effect of prazosin on the symptoms of benign prostatic hypertrophy for patients of general practitioners. SETTING AND PATIENTS: Eighty-two general practitioner patients from 317 who were identified as being eligible for inclusion in the trial. They were randomly allocated to receive either prazosin or placebo for the first 3 month arm then crossed-over for the second 3 months. RESULTS: Seventy-six patients completed the trial. An analogue scale of patient rating of symptoms showed a statistically significant decrease in symptoms for patients taking prazosin when compared with patients taking placebo, regardless of the order in which they had been administered. A total symptom score and an obstructive symptom score for benign prostatic hypertrophy showed a statistically significant difference between the two treatments at 4 weeks. A difference was still apparent at 8 and 12 weeks but it was not statistically significant. No difference was detected for irritative symptoms. CONCLUSION: Prazosin may have a limited place in the management of benign prostatic hypertrophy.

Aged↗
PubMed1992

The importance of hypertension in the aetiology of infarctive and haemorrhagic stroke. The Lower Hunter Stroke Study.

OBJECTIVE: To determine the importance of hypertension in the aetiology of infarctive and haemorrhagic stroke in persons aged 35-69 years. DESIGN: A population-based case-control study. SETTING: Lower Hunter Region community. SUBJECTS: One hundred and ninety patients with a first stroke were identified from a register, including all hospital admissions and death certificates in the Region, and compared with 496 control subjects obtained from a random population sample of the same community. MAIN OUTCOME MEASURE: First event of stroke (fatal or non-fatal). RESULTS: Twenty-seven per cent of those with a haemorrhagic stroke, compared with 2% of those with infarctive stroke, died before hospital admission; the in-hospital mortality was 15% and 9%, respectively. Twenty-one per cent of control subjects, compared with 51% of those with stroke, were currently receiving treatment for hypertension. By logistic regression analysis the odds ratio for receiving current treatment for hypertension in those with haemorrhagic stroke was 5.5 (95% confidence interval [CI], 2.36-12.8), compared with 2.53 (95% CI, 1.48-4.34) in those with infarctive stroke. Other differences between haemorrhagic and infarctive stroke included no excess risk in men for haemorrhagic stroke but an odds ratio of 3.51 (95% CI, 1.83-6.74) for infarctive stroke; and a steep risk gradient for obesity in haemorrhagic but not in infarctive stroke. Cigarette smoking carried a non-significant odds ratio of around 1.5, with no difference between stroke type. Among those who had ever been told that they had hypertension, 75% and 71% of patients with infarctive stroke and haemorrhagic stroke, respectively, and 61% of control subjects, were currently receiving treatment for hypertension. In those stroke patients who were currently being treated for hypertension, 63% had a pre-admission diastolic blood pressure of 90 mmHg or more. The mean diastolic blood pressure levels on admission were 10 mmHg higher than the latest recorded pre-hospital measurements and fell to 10 mmHg lower than the levels recorded before hospital admission by the time of discharge. CONCLUSION: Hypertension is important in the aetiology of both infarctive and haemorrhagic strokes, although it may be more important in haemorrhagic stroke, and there appear to be other aetiological differences between stroke types. Most of the patients with a history of hypertension were currently receiving treatment for hypertension, although blood pressure control before admission was not optimal.

Adult↗
PubMed1992

Postsclerotherapy hyperpigmentation. The role of serum ferritin levels and the effectiveness of treatment with the copper vapor laser.

Cutaneous pigmentation is a common complication of sclerotherapy of dilated lower limb veins. Histologic examination has shown that the pigment is due to hemosiderin deposition predominantly in the superficial dermis. Optimal technique will reduce the incidence of pigmentation but it is likely that patient factors such as total body iron storage may explain why some patients are more prone to develop pigmentation. Traditional exfoliation therapies have not given reliable reproducible results and there is need to develop an effective treatment without adverse sequelae. In this study 16 patients with refractory postsclerotherapy pigmentation were treated with the copper vapor laser. Within 3 months of treatment 11 (69%) had significant clearing of the pigmentation. Four (25%) had slight improvement and one patient had no discernible improvement. No adverse sequelae were reported or observed. The treated patients and 16 matched control patients who had not developed pigmentation were investigated with serum iron, ferritin and transferrin levels. There was a trend towards higher serum iron and ferritin levels and lower transferrin levels in the patients who developed pigmentation compared with those who did not develop this sequela. This trend was statistically significant for ferritin levels in patients 50 years of age and younger. The results indicate that serum ferritin may be a good indicator of susceptibility to postsclerotherapy pigmentation.

Adult↗
PubMed1991

Asthma in the vicinity of power stations: II. Outdoor air quality and symptoms.

To assess longitudinally the effect of living in the vicinity of coal-fired power stations on children with asthma, 99 schoolchildren with a history of wheezing in the previous 12 months were studied for 1 year, using daily diaries and measurements of air quality. The children had been identified in a cross-sectional survey of two coastal areas: Lake Munmorah (LM), within 5 km of two power stations, and Nelson Bay (NB), free from major industry. Daily air quality [sulphur dioxide (SO2) and nitrogen oxides (NOx)], respiratory symptoms, and treatment for asthma were recorded throughout the year. Measurements of SO2 and NOx at LM were well within recommended guidelines although they were several times higher than at NB: maximum daily levels in SO2 (micrograms/m3) were 26 at LM, 11 at NB (standard, 365); yearly average SO2 was 2 at LM, 0.3 at NB (standard, 60); yearly average NOx (micrograms/m3) was 2 at LM, 0.4 at NB (standard, 94). Marked weekly fluctuations occurred in the prevalence of cough, wheezing, and breathlessness, without any substantial differences between LM and NB. Overall, the prevalence of symptoms was low (10% for wheezing, 20% for any symptom). Whether the daily SO2 and NOx levels affected the occurrence of respiratory symptoms was investigated in children at LM using a logistic regression (Korn and Whittemore technique). For these children as a group, air quality measurements were not associated with the occurrence of symptoms.

Air Pollution↗
PubMed1991

Characteristics of spontaneously agglutinating Proteus mirabilis strains from bacteriuric patients.

Out of 210 Proteus mirabilis isolates from bacteriuric patients a total of eight spontaneously agglutinating strains were found. SDS-PAGE analysis of their lipopolysaccharides (LPS), the separation of polysaccharide fractions (PS) by gel filtration, and chemical characterization of PSs were performed. Out of the eight strains one S form and one mutant classified as Rc were detected. The remaining six strains were recognized as Ra and intermediate forms. When tested in a hematogenous infection model in mice, the P. mirabilis Rc mutant survived in kidneys for at least two weeks, while the Re mutant used as control was eliminated within 20 h after the challenge. These data indicated that strains of P. mirabilis may be pathogenic even if they express very incomplete LPS.

Adult↗
PubMed1990

Hypertension control and the risk of myocardial infarction and stroke: a population-based study.

A population-based case-control study was performed to determine the importance of the presence of hypertension and the control of blood pressure level during treatment for hypertension on the occurrence of acute myocardial infarction (AMI) and stroke in persons aged 35-69 years in the Hunter Region community. Patients with a first episode of AMI or stroke were identified from community-based heart attack and stroke registers and compared with control subjects obtained from a random population sample from the same community. Twenty per cent of control subjects were currently receiving treatment for hypertension compared with 37% of patients with myocardial infarction (odds ratio adjusted for age, sex and several other possible confounding variables, 2.6; 95% confidence interval (CI), 1.9-3.4) and 51% of patients with stroke (adjusted odds ratio, 3.5; 95% CI, 2.3-54). Among those who had ever been told they had hypertension, 71%, 73% and 59% of patients with AMI, patients with stroke and control subjects, respectively, were receiving treatment at the time of the AMI or the stroke or at the time of the survey (control subjects). For those receiving treatment for hypertension, blood pressure levels were obtained from the records of their general practitioner. Despite similar pretreatment levels the last recorded blood pressure level (either before the survey of the development of AMI or stroke) was higher among those who developed AMI or stroke than those in the control group. Those with a treated diastolic blood pressure of less than 80 mmHg appeared to be at a higher risk of both AMI and stroke than those with a treated diastolic blood pressure level of 80-89 mmHg, but the difference was not statistically significant. Randomised controlled trials do not show a reduction in rates of AMI in response to a reduction of blood pressure. Nevertheless our findings suggest that the presence of hypertension and poor control of blood pressure levels despite treatment may be important aetiologically both for AMI and stroke occurrence.

Adult↗
PubMed1990

Differences in modifiable cardiovascular disease risk factors in Australian schoolchildren: the results of a nationwide survey.

Two thousand four hundred schoolchildren ages 9, 12, and 15 years were randomly selected to participate in the Health and Fitness Survey of Australian Schoolchildren in 1985. Data on blood lipids, aerobic fitness, blood pressure, and obesity were obtained through physical measurement. Information on socioeconomic status and ethnic origin was collected via questionnaire. Serum total cholesterol and low and high-density lipoprotein cholesterol were lowest in the oldest age group. Girls had significantly higher serum lipid levels, the difference being greatest at 15 years. However, comparison of the total cholesterol/high-density lipoprotein cholesterol ratio showed a trend in the direction of decreasing risk with increasing age for girls, with the reverse being found in boys. Fifteen-year-old girls were also the fattest and least fit of all the children, but had significantly lower systolic and diastolic blood pressures than their male peers. Children of Asian ethnic origin had significantly lower systolic and diastolic blood pressures and a significantly higher mean high-density lipoprotein cholesterol and were less likely to be overweight compared with other ethnic groups. Children from Mediterranean/Middle-East countries were significantly fatter and had a higher mean diastolic blood pressure than the other ethnic groups. These differences were detectable at age 9 years. Children from lower socioeconomic backgrounds were fatter and had a significantly lower mean high-density lipoprotein cholesterol and higher mean serum triglyceride levels. As with ethnic origin, these differences were detectable at age 9 years. The results demonstrate that age, sex, ethnic origin, and socioeconomic status can be used as variables to describe mean differences in the levels of cardiovascular risk factors in the national population of children. As some elevations in risk factors appear to be present in the youngest age group and these levels correlate with fatty streak and fibrous plaque formation in young adulthood, preventive programs should aim at intervention prior to puberty.

Adolescent↗
PubMed1990

Cosmetic leg veins: evaluation using duplex venous imaging.

The records of 305 consecutive patients who had presented with cosmetic symptoms related to varicose and/or spider veins over a 12-month period were studied. Following clinical assessment, 250 (82%) patients were referred for duplex venous imaging. A total of 500 lower limbs were evaluated; 236 (47%) were documented to have incompetence in the superficial venous system (long or short saphenous veins). Only 6 (1%) limbs had deep venous incompetence and 45 (9%) limbs were found to have perforator incompetence. Short saphenous vein incompetence was found in 59 (12%) limbs. In the long saphenous vein there was a consistent pattern of an increasing incidence of incompetence from the saphenofemoral junction down to the below-knee segment. The duplex imaging findings were applied to determine the optimal treatment, ie, whether surgery, sclerotherapy, or a combination of both would provide the best short- and long-term results. The possible etiology and pathophysiology of spider and varicose veins are discussed in relation to these results.

Adolescent↗
PubMed1990

Urinary uric acid:creatinine ratio, serum erythropoietin, and blood 2,3-diphosphoglycerate in patients with obstructive sleep apnea.

A noninvasive, inexpensive method of excluding significant sleep-associated hypoxemia would be desirable for patients being investigated and treated for obstructive sleep apnea (OSA). Sixty-eight such patients provided specimens before and after sleep studies for estimation of urinary uric acid:creatinine ratio (UA:Cr), serum erythropoietin (EPO), and blood 2,3-diphosphoglycerate (2,3-DPG). Mean (SD) morning 2,3-DPG was higher in 26 patients with overnight hypoxemia than in 42 normoxemic patients (2.54 [0.46] versus 2.24 [0.44] mmol/L; p = 0.01). Neither overnight change nor absolute values of serum EPO or urinary UA:Cr were significantly different between hypoxemic and normoxemic groups. There was a diurnal variation in serum EPO in normoxemic patients (P.M. EPO = 14.8 [7.1] mU/ml; A.M. EPO = 10.7 [7.1] mU/ml; p less than 0.05) but not in hypoxemic patients. Eighteen hypoxemic patients were restudied after using nasal continuous positive airway pressure (nCPAP) for at least 4 wk. Seven normoxemic patients not using nCPAP were restudied after a similar time. There were no significant differences between pretreatment and posttreatment nights in absolute values or percentage overnight change of blood 2,3-DPG or serum EPO in either group. In the hypoxemic (nCPAP) group, overnight change in urinary UA:Cr was lower on the second night (p = 0.04); there was no significant change in the control group. We conclude that although urinary UA:Cr, serum EPO, and 2,3-DPG may be physiologically related to hypoxemia, none of these measures can be used to predict accurately the presence of moderate nocturnal hypoxemia in patients with OSA or in monitoring the effect of their therapy.

2,3-Diphosphoglycerate↗
PubMed1989

Cigarette smoking in Australian schoolchildren.

Six thousand, four hundred and fifty-one schoolchildren who were aged nine to 15 years completed a questionnaire about their patterns of cigarette use, as part of the nation-wide Health and Fitness Survey of Australian Schoolchildren which was conducted in 1985. The survey yielded figures for the prevalence of cigarette smoking by age, sex, socioeconomic status and ethnic origin. It also provided data on the relationship between parental smoking and smoking in children. By the age of 15 years, 32.4% of the girls and 26.0% of the boys in the study sample had smoked at least one cigarette in the seven days before they were surveyed. In some of the age-groups, the average number of cigarettes that were consumed by girl smokers equalled or exceeded that of their male counterparts. There were no significant differences in the prevalence of current cigarette smoking with differences in socioeconomic status. This finding contrasts with the pattern of use in adults. Ethnic origin was a statistically-significant predictor of smoking behaviour in children. Significantly-fewer children of Asian ethnic origin were current smokers. Parental smoking status also appeared to be an important determinant of smoking behaviour in schoolchildren. This influence was more important for girls than for boys, particularly when the mother was a smoker. The over-all findings suggest that many features of the adult pattern of cigarette use are established by the age of 15 years. The findings also supported the trend towards increased cigarette consumption by girls compared with boys that was noted by earlier researchers. These findings should encourage a serious reappraisal of the role of cigarette advertising in the promotion of smoking in young persons.

Adolescent↗